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Saturday, May 20, 2017

Navicular Fracture: Email Advice

I am a 41-year-old single mom of two very active boys ages nine and eight. In April, I walked right off of a pedestrian sidewalk not realizing it had ended and landed right on top of and rolled my foot and ankle.

I have been in one of the immobile walking boot since 4/17. They elected not to cast immediately due to an open wound.
The fracture was only visualized on the lateral x-ray. Was not until we got the CT scan that we realize the extent of the injury.

What do you feel is my best option? The doctor feels a compression screw to attach the two pieces or six weeks in a hard cast at this point. I continue to use KT tape as well as lidocaine patches. I am in active as I can be given my current situation.

If I do get out of the house I remove my boot each time I drive and also use the knee scooter when there are long distances to travel.

Any advice or input would be greatly appreciated

Dr Blake's comment: This can heal, although there is no guarantee, with casting and bone stimulator, as long as everyone agrees there is good alignment and the blood supply had not been compromised. There is just so much pressure on the fragment, and the navicular itself is known for its bad blood supply, and there is another injury at the cuboid, and as you weight bear the talus pushes against the navicular with tremendous force. You are young, and need to be active quickly with your responsibilities, so I think the surgical screws across the fragments would do you best. That being said, every injury, and especially if you have surgery, requires a lot of rehab. As a single mom, you may not have the time to dedicate, especially if there are problems or complications with the surgery. That commitment has to be worked out. Also, the fractures are the obvious, but there can be hidden injuries that will slow the recovery.  At least, as the article below points out, a simpler percutaneous screw fixation will dramatically reduce the post op recovery time over a completely open procedure. This 6 weeks post injury is important to let the soft tissue heal, and any change of infection pass, before the bone is fixated. I hope this helps some. Surgery makes sense if percutaneous where the alignment is good. Should allow activity faster overall.  But, like you should not be driving now, if the surgeon tells you some restriction, you have to oblige whatever the costs. Surgery just starts the injury over again, but the bone will heal quicker this time. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.